Dr. Anup Ramani is one of the best Uro oncologist, Surgeon in Mumbai, India providing Robotic Surgery and Treatment for Prostate Cancer, Kidney Tumor Surgery/Stone Removal, Urinary Bladder Cancer and Adrenal Gland Treatment, Enlarged Prostate Surgery and treatment, Penis Cancer/Partial Penectomy/Robotic Pyeloplasty Surgery and Treatment.
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Case Study on Minimal Invasive Robotic Radical Prostatectomy for Prostate Cancer

26 Jul
By Dr. Anup Ramani

About Robotic Radical Prostatectomy for Prostate Cancer

Prostate cancer, a common malignancy among men, poses significant health challenges globally. Early detection and effective treatment are crucial to improving patient outcomes. Robotic radical prostatectomy, a minimal invasive surgical technique, represents a significant advancement in treating this condition.

By employing robotic assistance, surgeons can perform precise and less invasive procedures, enhancing recovery times and reducing complications.

This case study explores the journey of a 68-year-old male who underwent robotic radical prostatectomy for prostate cancer, highlighting the diagnostic process, surgical procedure, and post-operative recovery.

2. Patient Background

The patient, a 68-year-old male, was initially asymptomatic and underwent a routine health checkup. His tests were mostly normal, but his Prostate-Specific Antigen (PSA) level was notably elevated at 8.5 ng/mL. Typically, a normal PSA level is below 4 ng/mL, which raised concerns.

This abnormal result prompted further investigation, leading to the referral to Dr. Anup Ramani, a renowned Uro-Oncologist in Mumbai. Despite no symptoms, the elevated PSA level suggested the need for a more thorough examination to rule out or confirm any underlying issues.

3. Prostate Cancer Diagnosis Process

  • Consultation with Family Doctor: Upon discovering the high PSA level, the patient’s family doctor recommended seeking specialized care. The elevated PSA, while not definitive for cancer, warranted further investigation due to its significance as a potential marker for prostate abnormalities.
  • Visit to Prostate Cancer Surgeon: Dr. Anup Ramani, with his extensive expertise in uro-oncology, conducted a detailed examination. Given the patient’s age and elevated PSA, Dr. Ramani suggested advanced diagnostic imaging to understand the cause better.
  • MRI of the Prostate Gland: The MRI revealed a suspicious area within the prostate gland, which required further investigation. MRI scans are crucial in assessing the extent and localization of potential prostate abnormalities.
  • Trans Rectal Ultrasound Guided Biopsy: To confirm the presence of cancer, a Trans rectal ultrasound-guided biopsy was performed. This procedure, conducted on an outpatient basis, involves collecting tissue samples from the prostate to examine for cancerous cells. The biopsy, though minimal invasive, is critical in providing a definitive diagnosis.
Prostate Cancer

4. Staging and Evaluation

  • PET Scan for Cancer Staging: A PET scan was ordered to determine if the cancer had spread beyond the prostate. This imaging technique is vital for assessing the extent of cancer and planning appropriate treatment strategies.
  • PET Scan Results and Implications: The PET scan indicated that the cancer was confined to the prostate and had not metastasized to other areas. This localized stage was favorable for surgical intervention, as it suggested that the disease had not progressed beyond the organ.

5. Prostate Cancer Surgery and Treatment Recommendation

  • Decision for Radical Prostatectomy: Based on the diagnosis and staging, Dr. Ramani recommended a radical prostatectomy, which involves the complete removal of the prostate gland. This decision was based on the need to eliminate cancer and prevent recurrence.
  • Robotic Radical Prostatectomy: The surgery was planned using robotic assistance, a technique that allows for precise and controlled removal of the prostate with minimal physical incisions. Robotic surgery offers several benefits, including reduced blood loss, shorter recovery times, and improved surgical outcomes compared to traditional methods.

6. Prostate Surgical Procedure

  • Preparation for Surgery: Prior to the procedure, the patient underwent thorough preoperative assessments to ensure readiness. This preparation included a review of medical history, physical examination, and pre-surgical tests to confirm that the patient was fit for the surgery.
  • Surgical Procedure: The robotic radical prostatectomy was performed through six small incisions in the abdomen. The robotic system, controlled by Dr. Ramani, provided enhanced precision in removing the prostate while preserving surrounding tissues and nerves. The procedure was completed successfully, with a focus on minimizing post-operative complications.

7. Post-Operative Care After Prostate Cancer Surgery

  • Hospital Recovery: Following the surgery, the patient was monitored in the hospital for three to four days. During this time, the medical team ensured proper recovery and managed any immediate post-surgical needs, such as pain management and wound care.
  • Discharge and Follow-Up: After a successful hospital stay, the patient was discharged with detailed instructions for home care. Follow-up appointments were scheduled to monitor recovery progress and assess the effectiveness of the surgery.

8. Recovery and Lifestyle Post-Surgery

  • Return to Daily Activities: The patient resumed normal daily activities within two weeks of surgery. The minimal invasive nature of robotic surgery contributed to a faster recovery, allowing the patient to return to work and personal activities sooner than with traditional surgical methods.
  • Long-Term Monitoring: Long-term follow-up involved annual PSA tests to monitor for any potential recurrence of cancer. Regular monitoring is crucial to ensuring continued health and detecting any issues early if they arise.

9. Expert Opinion: Dr. Anup Ramani

  • Profile of Dr. Anup Ramani: Dr. Ramani is an internationally recognized expert in robotic surgery for uro-oncological cancers. With over 20 years of experience, he has performed more than 2000 robotic surgeries, demonstrating his expertise and commitment to advancing cancer treatment.
  • Insights on Robotic Surgery: Dr. Ramani emphasizes the benefits of robotic surgery, including enhanced precision, reduced recovery times, and improved patient outcomes. His extensive experience underscores the importance of specialized care in achieving successful treatment results.

10. Prostate Cancer Treatment in India

  • Overview of Prostate Cancer Treatment Options: In India, prostate cancer treatment options include surgery, radiation therapy, and hormone therapy. Robotic radical prostatectomy represents a modern and effective surgical approach, providing patients with a minimal invasive alternative.
  • Advancements in Urological Oncology: The field of urological oncology in India has seen significant advancements, with improved diagnostic tools and treatment methods contributing to better patient outcomes and quality of life.

11. Robotic Surgery for Prostate Cancer

  • Technological Advancements: Robotic surgery has revolutionized prostate cancer treatment by incorporating advanced technology that allows for greater precision and control during surgery. This innovation has led to improved surgical outcomes and reduced complications.
  • Global Comparison: Compared to traditional surgery, robotic surgery offers enhanced benefits such as reduced blood loss, shorter hospital stays, and quicker recovery. Global studies have demonstrated its effectiveness and success in treating prostate cancer.

12. Conclusion

  • Summary of Case Study: This case study highlights the journey of a patient who underwent robotic radical prostatectomy for prostate cancer. The diagnosis, surgical procedure, and recovery process illustrate the effectiveness of modern surgical techniques in treating prostate cancer.
  • Impact of Robotic Surgery: The use of robotic surgery has demonstrated significant advantages, including reduced recovery times and improved surgical precision. This approach has positively impacted the patient’s quality of life and treatment outcomes.

13. FAQs about Prostate Cancer and Robotic Surgery

Prostate cancer is a malignancy that develops in the prostate gland. It is common in older men and can vary in severity from slow-growing to aggressive.

Diagnosis typically involves measuring PSA levels, performing a biopsy, and using imaging techniques such as MRI and PET scans to assess the extent of the disease.

This is a minimal invasive surgical procedure that uses robotic technology to remove the prostate gland with precision and minimal incisions.

Benefits include reduced blood loss, shorter hospital stays, faster recovery, and less postoperative pain compared to traditional surgery.

Recovery time varies but generally involves a few days in the hospital and a few weeks of reduced activity before returning to normal routines.

Follow-up care includes regular PSA tests to monitor for any recurrence of cancer and periodic consultations with the surgeon.

Risks are minimal but may include infection, bleeding, or urinary incontinence. However, robotic surgery often reduces these risks compared to traditional methods.

Robotic surgery is highly effective, with studies showing similar or improved outcomes compared to traditional surgery, including lower rates of complications and better functional recovery.

Costs vary depending on the treatment type and facility. Robotic surgery, while advanced, is offered at competitive rates in Mumbai, India compared to other countries.

Consider factors such as the surgeon’s experience, expertise in robotic surgery, patient reviews, and the reputation of the medical facility.

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Dr. Anup Ramani is one of the best Uro oncologist, Surgeon in Mumbai, India providing Robotic Surgery and Treatment for Prostate Cancer, Kidney Tumor Surgery/Stone Removal, Urinary Bladder Cancer and Adrenal Gland Treatment, Enlarged Prostate Surgery and treatment, Penis Cancer/Partial Penectomy/Robotic Pyeloplasty Surgery and Treatment.

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PARTIAL PENECTOMY
  • Partial penectomy is done in cases where glans and distal penis is involved with carcinoma. 
  • Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
  • Patients who develop stones in the kidney or ureter, often experience severe pain.
  • This condition usually needs a procedure to remove the kidney stones.
  • This procedure is called ureteroscopy and is performed very commonly.
  • It does not require any cuts and hence it is painless.
  • The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
  • The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
  • The procedure takes about 40-50 minutes. 
  • A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
  • Patient is mobile and walking in the room the same evening.
  • Hospital stay is one night and patient is discharged the next day after removal of the catheter.
  • Patient has to come back after six weeks to remove the stent in the kidney.
  • Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
  • We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
  • Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
  • This procedure is called TURP and is performed very commonly.
  • It does not require any cuts and hence it is painless.
  • The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
  • The overgrown prostate is dissolved with a laser bloodlessly.
  • The procedure takes about 40 minutes.
  • A catheter (urine pipe) is kept after the procedure to drain the bladder.
  • Patient is mobile and walking in the room the same evening.
  • Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
  • Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
  • We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR

  • Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.

  • Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.

  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).

  • Dr. Ramani then sits in the controlling console to perform the surgery.

  • On an average, a robotic adrenalectomy takes one hour.

  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.

  • A urine catheter and bag to drain the bladder is inserted during surgery.

  • A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.

  • Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.

  • The drain pipe, if kept, is removed in the room on day 2 after surgery.

  • The catheter is removed on day two after surgery.

  • Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).

  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.

RETURN TO ACTIVITY

  • On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.

  • Heavy activities like running, weight lifting can be resumed after a month

FOLLOW UP AFTER SURGERY

  • Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
    Local patients usually meet Dr. Ramani after two weeks to discuss report.

  • Outstation patients are counselled on a phone consultation.

ROBOTIC SURGERY FOR BLADDER CANCER
  • Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
  • Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
  • Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
  • Dr. Ramani then sits in the controlling console to perform the surgery.
  • On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
  • A urine catheter and bag to drain the new bladder is inserted during surgery.
  • Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
  • Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
  • The drain pipes are removed in the room on day 3-5 after surgery.
  • Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
  • On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
  • Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY

  • Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.

  • Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.

  • Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.

  • If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.

ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
  • Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
  • relatively easier but still requires significant experience to consistently deliver results.
  • Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
  • The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
  • Dr. Ramani then sits in the controlling console to perform the surgery.
  • On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
  • The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
  • A urine catheter and bag to drain the bladder is inserted during surgery.
  • A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
  • Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
  • The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
  • Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
  • Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
  • On the day of discharge, patient is totally self- sufficient. 
  • They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. 
  • Almost all patients are back to work within 2-3 weeks of surgery.
  • Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
  • Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
  • Local patients usually meet Dr. Ramani after two weeks to discuss report. 
  • Outstation patients are counselled on a phone consultation.